Provider Demographics
NPI:1720475692
Name:GILLELAND, KRISTIN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:GILLELAND
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 EDWARD CURD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5791
Mailing Address - Country:US
Mailing Address - Phone:615-791-2630
Mailing Address - Fax:
Practice Address - Street 1:3000 EDWARD CURD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5607
Practice Address - Country:US
Practice Address - Phone:615-791-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3994363AS0400X, 363A00000X
TN16992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant